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Wisconsin rates for HCPCS J9200

Floxuridine 500 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,251.85 / $8,251.10 / $9,475.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,128.02 / $4,169.30 / $4,788.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,160.03 / $7,636.84 / $9,205.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,128.02 / $4,128.02 / $5,572.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,604.83 / $7,430.44 / $7,566.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,128.02 / $5,867.41 / $10,733.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,128.02 / $4,786.00 / $7,308.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $4,128.02 / $4,540.82
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.54 / $8,256.04 / $8,256.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.60 / $4,125.55 / $4,538.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,125.55 / $4,592.60 / $17,614.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.60 / $4,128.02 / $4,540.82
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.54 / $8,256.04 / $8,256.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,128.02 / $4,436.54 / $12,334.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,988.33 / $4,128.02 / $19,941.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,128.02 / $7,339.43 / $17,614.63
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,125.55 / $4,125.55 / $4,125.55
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.49 / $5,795.74 / $5,795.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,128.02 / $4,251.85 / $4,912.34